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Law TH, Ng CP, Poi AWH. The sources of the Kuznets relationship between the COVID-19 mortality rate and economic performance. Int J Disaster Risk Reduct 2022; 81:103233. [PMID: 36093278 PMCID: PMC9444851 DOI: 10.1016/j.ijdrr.2022.103233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/11/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
This paper discusses the findings of an empirical analysis of the Kuznets, or reverse U-shaped relationship, between the COVID-19 mortality rate and economic performance. In the early stages of economic development, the COVID-19 mortality rate is anticipated to rise with rising economic activity and urbanization. Eventually, the mortality rate decreases at higher economic development levels as people and the government are more capable of investing in disease abatement measures. The quality of political institutions, wealth distribution, urbanization, vaccination rate, and improvements in healthcare systems are hypothesized to affect the COVID-19 mortality rate. Examining this relationship can be effective in understanding the change in the COVID-19 mortality rate at different economic performance stages and in identifying appropriate preventive measures. This study employed the negative binomial regression to model a cross-sectional dataset of 137 countries. Results indicated that the relationship between the per-head gross domestic product (GDP) level and the COVID-19 mortality rate appeared to follow a pattern like the Kuznets curve, implying that changes in institutional quality, healthcare advancements, wealth distribution, urbanization, vaccination rate, and the percentage of the elderly population were significant in explaining the relationship. Improvement of the healthcare system has a notable effect on lowering the COVID-19 mortality rate under more effective government conditions. Additionally, the results suggested that a higher per-head GDP is required to reverse the rising trend of the mortality rate under higher income inequality. Based on these results, preventive measures, and policies to reduce COVID-19 mortalities were recommended in the conclusion section.
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Affiliation(s)
- Teik Hua Law
- Road Safety Research Center, Faculty of Engineering, Universiti Putra Malaysia, 43400 Selangor, Malaysia
| | - Choy Peng Ng
- Civil Engineering Department, Faculty of Engineering, Universiti Pertahanan Nasional Malaysia, 57000 Kuala Lumpur, Malaysia
| | - Alvin Wai Hoong Poi
- Road Safety Engineering and Environment Research Center, Malaysian Institute of Road Safety Research, 43000 Kajang, Selangor, Malaysia
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Rodríguez-Sánchez B, Peña-Longobardo LM, Oliva-Moreno J. The employment situation of people living with HIV: a closer look at the effects of the 2008 economic crisis. Eur J Health Econ 2022; 23:485-497. [PMID: 34477995 DOI: 10.1007/s10198-021-01372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
This study aims to assess the determinants of employment probabilities among people living with Human Immunodeficiency Virus (HIV) during a 15-year period (2001-2016) in Spain, focusing on the possible effects of occurrences such as the 2008 economic crisis. The probability of people living with HIV having a job was evaluated by applying several multivariate probit regression models. Differences between the employment status of people living with HIV and that of the general population were evaluated by applying genetic matching regression models. With respect to the former evaluation, for people living with HIV, the period before the crisis (2001-2007) was associated with a probability of being employed that was 2.43 percentage points (p.p.) higher than during the crisis, and the period after the crisis (2014-2016) with a probability that was 7.58 p.p. lower than during the crisis. Greater effects were also observed among males, the probability of being in employment before the economic crisis being higher (by 2.26 p.p.) and lower after the crisis (- 3.41 p.p.) than among women, and among those infected through drug use (6.18 p.p. and - 7.34 p.p. before and after the crisis, respectively), than among those infected through sex. When analysing the differences with respect to the general population, people living with HIV reported lower probabilities of being employed: by - 18 p.p. before the crisis, by - 15 p.p. during the crisis (years 2008-2013) and by - 10 p.p. after the crisis, implying a convergence in the prospects of employment with the passage of the years. Those differences were greater for people of basic educational level (- 23 to - 16 p.p.), a weaker immune system (- 34 p.p. to - 21 p.p.) and those infected through the use of drugs (- 31 p.p. to - 26 p.p.). Although the results suggest that the economic crisis had a greater effect on the employment prospects of people living with HIV, and that effect is still felt by that group, our findings also point towards a convergence of their employment prospects with those of the general population, over the 15-year period assessed. An analysis of the employment situation of people living with HIV might have helped when designing job-seeking methods and policies on the working environment, especially through the 15-year period considered, when the economic crisis had a greater effect on the job market.
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Affiliation(s)
- Beatriz Rodríguez-Sánchez
- Faculty of Communication and Humanities, University Camilo José Cela, Urb. Villafranca del Castillo, Calle Castillo de Alarcón, 49Villanueva de la Cañada, 28692, Madrid, Spain.
| | - Luz María Peña-Longobardo
- Faculty of Law and Social Sciences, Economic Analysis and Finances Department, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Juan Oliva-Moreno
- Faculty of Law and Social Sciences, Economic Analysis and Finances Department, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
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Augusto GF, Hodges-Mameletzis I, Karanikolos M, Abrantes A, Martins MRO. HIV prevention and treatment in Southern Europe in the aftermath of bailout programmes. Eur J Public Health 2021; 30:967-973. [PMID: 32363377 DOI: 10.1093/eurpub/ckaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The global financial crisis impacted public health in Europe, and had a particularly critical detriment to health systems in Southern Europe. We aim to describe HIV response and progress towards the current global HIV targets in specific Southern European countries, which received financial adjustment programmes. METHODS We examined and compared a set of HIV indicators in Cyprus, Greece, Portugal and Spain. The indicators included: (i) HIV epidemiology; (ii) adoption of WHO's 'Treat All' recommendation; (iii) progress towards the UNAIDS global targets of 90-90-90; (iv) adoption/implementation of pre-exposure prophylaxis (PrEP); and (v) adoption/implementation of WHO's HIV self-testing (HIVST) recommendation. RESULTS HIV incidence varied across countries since 2010, with sustained declines in Portugal and Spain, and marked increases in Greece and Cyprus. By 2016, all four countries have adopted WHO's 'Treat All' recommendation, leading to a marked increase in people receiving ART. Improvements were seen in all 90-90-90 targets, with Portugal achieving those in 2017, but Greece lagging somewhat behind, as of 2016. Portugal and Spain have also started implementing PrEP, and Greece has completed a pilot with no additional access to PrEP for pilot participants and no national programme in place. Cyprus has been the slowest in terms of adopting PrEP and HIVST. CONCLUSIONS Countries need to focus on prioritizing effective and comprehensive prevention measures, including HIVST and PrEP, and scale-up access to quality treatment and care for those diagnosed, in order to accelerate the reduction of new HIVs infections and successfully meet the global targets for HIV treatment.
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Affiliation(s)
- Gonçalo F Augusto
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Lisbon, Portugal
| | | | - Marina Karanikolos
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexandre Abrantes
- Department of Health Policy and Administration, Escola Nacional de Saúde Pública - Universidade NOVA de Lisboa (ENSP-UNL), Lisbon, Portugal
| | - Maria R O Martins
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Lisbon, Portugal
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Abstract
This paper uses the mixed frequency vector autoregression model to explore the impact of economic fluctuations on infectious diseases mortality (IDM) from China perspective. We find that quarterly gross domestic product (GDP) fluctuations have a negative impact on the annual IDM, indicating that the mortality of infectious diseases varies counter-cyclically with the business cycle in China. Specifically, IDM usually increases with deterioration in economic conditions, and vice versa. The empirical results are consistent with the hypothesis I derived from the theoretical analysis, which highlights that economic fluctuations can negatively affect the mortality of infectious diseases. The findings can offer revelations for the government to consider the role of economic conditions in controlling the epidemic of infectious diseases. Policymakers should adopt appropriate and effective strategies to mitigate the potential negative effects of macroeconomic downturns on the mortality of infectious diseases. In the context of the COVID-19 pandemic, these analyses further emphasize the importance of promoting economic growth, increasing public health expenditure, and preventing and controlling foreign infectious diseases.
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Affiliation(s)
- Ting-Ting Sun
- School of Economics, Qingdao University, Qingdao, China
| | - Ran Tao
- Qingdao Municipal Center for Disease Control and Preventation, Qingdao, China
| | - Chi-Wei Su
- School of Economics, Qingdao University, Qingdao, China
| | - Muhammad Umar
- School of Economics, Qingdao University, Qingdao, China
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Zilidis C, Papagiannis D, Kyriakopoulou Z. Did Economic Crisis Affect Mortality Due to Infectious Diseases? Trends of Infectious Diseases Mortality in Greece Before and After Economic Crisis. Cureus 2021; 13:e13621. [PMID: 33816020 PMCID: PMC8010371 DOI: 10.7759/cureus.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Economic crisis and the restrictive policies applied in Greece and other countries raise questions about whether financial crises may affect the declining trend of infectious diseases. The aim of this study is to explore the impact of the economic crisis on mortality due to infectious diseases in Greece and its possible correlation with socio-economic variables affected by the crisis. Methods Data including all deaths due to infectious diseases in Greece during 2001-2016 were analyzed. Annual total and cause-specific standardized death rates (SDR) and age-specific mortality rates were calculated. Cumulative SDRs and standardized rate ratios of the exposed and the non-exposed to austerity periods were computed. The correlation of mortality with Gross Domestic Product (GDP), unemployment, long-term unemployment and hospital expenditure was explored. Results During the exposed-to-austerity period, the SDR of infectious diseases recorded a significant increase by 5% (2.4%-7.7%), exhibiting different trends in the various groups of diseases. The cause-specific SDR increased significantly in intestinal infections, viral diseases, pneumonia, and influenza, and declined in tuberculosis and meningitis. Overall mortality was positively correlated with GDP and unemployment, and adversely with hospital expenditure. Conclusions The mortality of infectious disease was adversely affected by economic crisis and austerity, but the effects were found disease-dependent, with significant differences between the various groups of infectious disease. Unemployment and hospital expenditure were the main socio-economic determinants of mortality. Causal mechanisms of the impact remain unclear, requiring further research.
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Affiliation(s)
- Christos Zilidis
- Epidemiology and Social Medicine, University of Thessaly, Larissa, GRC
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Dong H, Li Z, Failler P. The Impact of Business Cycle on Health Financing: Subsidized, Voluntary and Out-of-Pocket Health Spending. Int J Environ Res Public Health 2020; 17:ijerph17061928. [PMID: 32188003 PMCID: PMC7143791 DOI: 10.3390/ijerph17061928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 11/23/2022]
Abstract
Diverse types of healthcare systems in countries offer opportunities to explore the heterogeneous sources of health financing. This paper widely explores the effect of the business cycle on subsidized, voluntary and out-of-pocket health spending in 34 countries with different types of healthcare systems, by the methodology of hierarchical linear modeling (HLM). We use a panel of annual data during the years from 2000 to 2016. It further examines the business cycle-health financing mechanism by inquiring into the mediating effect of external conditions and innovative health financing, based on the structural equation modeling (SEM). The empirical results reveal that the business cycle harms subsidized spending, whereas its effect on voluntary and protective health spending is positive. Results related to the SEM indicate that the mediating effect of external conditions on the relationship between the business cycle and health financing is negative. However, we find that the business cycle plays a positive effect on health financing through innovative health financing channels. Thus, designing and implementing efforts to shift innovative health financing have substantial effects on the sustainability of healthcare systems.
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Affiliation(s)
- Hao Dong
- School of Economics and Statistics, Guangzhou University, Guangzhou 510006, China;
| | - Zhenghui Li
- Guangzhou International Institute of Finance and Guangzhou University, Guangzhou 510006, China
- Correspondence: ; Tel.: 86-1335-285-7358
| | - Pierre Failler
- Economics and Finance Group, Portsmouth Business School, University of Portsmouth, Portsmouth PO1 3DE, UK;
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Llavero-Molino I, Sánchez-Ocón MT, Pérez-Morente MÁ, Espadafor-López B, Martín-Salvador A, Martínez-García E, Hueso-Montoro C. Sexually Transmitted Infections and Associated Factors in Homosexuals and Bisexuals in Granada (Spain) During the Period 2000-2015. Int J Environ Res Public Health 2019; 16:ijerph16162958. [PMID: 31426415 PMCID: PMC6719132 DOI: 10.3390/ijerph16162958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
Sexually transmitted infections (STIs) are a major public health issue. Previous research shows the vulnerability of the homosexual and bisexual population, as well as the influence of economic, political, and cultural determinants. The aim of this study was to describe the socio-demographic healthcare profile and the main risk factors associated with STIs in homosexuals and bisexuals seen at the STI clinic in Granada (Spain) during the years 2000–2015. Infection prevalences were compared between the economic crisis period (2008–2014) and the rest of the years analysed. A cross-sectional observational and analytical study was conducted by reviewing 261 clinical records of individuals with suspected or present infection. Univariate, bivariate, and multivariate analyses were performed. 91.2% of the individuals were men, and 8.8% were women, with the mean age being 28.61 (SD = 9.35, Range = 17–74) years old. The prevailing sexual orientation identity was homosexual. 94.2% were single. The main reason for consultation was HIV. Differences in prevalence were found between crisis and non-crisis years (OR = 3.91; 95% CI = 1.73–9.19). In conclusion, their profile was that of a young, single man suspecting possible HIV infection. STI prevalence was significantly higher in the years of economic recession in comparison to the rest of the years.
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Hunter PR, Colón-González FJ, Brainard J, Majuru B, Pedrazzoli D, Abubakar I, Dinsa G, Suhrcke M, Stuckler D, Lim TA, Semenza JC. Can economic indicators predict infectious disease spread? A cross-country panel analysis of 13 European countries. Scand J Public Health 2019; 48:351-361. [PMID: 31291826 DOI: 10.1177/1403494819852830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: It is unclear how economic factors impact on the epidemiology of infectious disease. We evaluated the relationship between incidence of selected infectious diseases and economic factors, including economic downturn, in 13 European countries between 1970 and 2010. Methods: Data were obtained from national communicable disease surveillance centres. Negative binomial forms of the generalised additive model (GAM) and the generalised linear model were tested to see which best reflected transmission dynamics of: diphtheria, pertussis, measles, meningococcal disease, hepatitis B, gonorrhoea, syphilis, hepatitis A and salmonella. Economic indicators were gross domestic product per capita (GDPpc), unemployment rates and (economic) downturn. Results: GAM models produced the best goodness-of-fit results. The relationship between GDPpc and disease incidence was often non-linear. Strength and directions of association between population age, tertiary education levels, GDPpc and unemployment were disease dependent. Overdispersion for almost all diseases validated the assumption of a negative binomial relationship. Downturns were not independently linked to disease incidence. Conclusions: Social and economic factors can be correlated with many infections. However, the trend is not always in the same direction, and these associations are often non-linear. Economic downturn or recessions as indicators of increased disease risk may be better replaced by GDPpc or unemployment measures.
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Affiliation(s)
| | | | | | | | - Debora Pedrazzoli
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | | | - Girmaye Dinsa
- T.H. Chan School of Public Health, Harvard University, USA
| | - Marc Suhrcke
- Centre for Health Economics, University of York, UK
| | | | - Tek-Ang Lim
- Science and International Office, French Public Health Agency, France
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Sweden
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Stenger MR, Baral S, Stahlman S, Wohlfeiler D, Barton JE, Peterman T. As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men. Sex Health 2019; 14:18-27. [PMID: 27585033 DOI: 10.1071/sh16104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/28/2016] [Indexed: 12/24/2022]
Abstract
The trajectory of sexually transmissible infection (STI) incidence among gay and other men who have sex with men (MSM) suggests that incidence will likely remain high in the near future. STIs were hyperendemic globally among MSM in the decades preceding the HIV epidemic. Significant changes among MSM as a response to the HIV epidemic, caused STI incidence to decline, reaching historical nadirs in the mid-1990s. With the advent of antiretroviral treatment (ART), HIV-related mortality and morbidity declined significantly in that decade. Concurrently, STI incidence resurged among MSM and increased in scope and geographic magnitude. By 2000, bacterial STIs were universally resurgent among MSM, reaching or exceeding pre-HIV levels. While the evidence base necessary for assessing the burden STIs among MSM, both across time and across regions, continues to be lacking, recent progress has been made in this respect. Current epidemiology indicates a continuing and increasing trajectory of STI incidence among MSM. Yet increased reported case incidence of gonorrhoea is likely confounded by additional screening and identification of an existing burden of infection. Conversely, more MSM may be diagnosed and treated in the context of HIV care or as part of routine management of pre-exposure prophylaxis (PrEP), potentially reducing transmission. Optimistically, uptake of human papillomavirus (HPV) vaccination may lead to a near-elimination of genital warts and reductions in HPV-related cancers. Moreover, structural changes are occurring with respect to sexual minorities in social and civic life that may offer new opportunities, as well as exacerbate existing challenges, for STI prevention among MSM.
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Affiliation(s)
- Mark Richard Stenger
- US Centers for Disease Control and Prevention - Division of STD Prevention, Mail Stop E-63 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Stefan Baral
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Shauna Stahlman
- Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Department of Epidemiology, 615N. Wolfe Street, Baltimore, MD 21205, USA
| | - Dan Wohlfeiler
- University of California San Francisco, San Francisco, CA 94143, USA
| | - Jerusha E Barton
- US Centers For Disease Control and Prevention - Division of STD Prevention (ORISE Fellow), Mailstop E-63, Atlanta, GA 30333, USA
| | - Thomas Peterman
- Centers for Disease Control and Prevention - Division of STD Prevention, Mailstop E-02 CDC, Atlanta, GA 30333, USA
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10
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Augusto GF, Dias SS, Abrantes AV, Martins MRO. HIV/AIDS length of stay in Portugal under financial constraints: a longitudinal study for public hospitals, 2009-2014. BMC Health Serv Res 2019; 19:303. [PMID: 31077218 PMCID: PMC6511190 DOI: 10.1186/s12913-019-4131-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients' length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients. METHODS Data used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals' financial situation (current ratio) was included. RESULTS For the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital's current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables. CONCLUSION Following the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals.
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Affiliation(s)
- Gonçalo F Augusto
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Rua da Junqueira 100, 1349-008, Lisbon, Portugal.
| | - Sara S Dias
- Epidoc Unit - CEDOC, NOVA Medical School - Universidade Nova de Lisboa (NMS-UNL), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.,Center for Innovative Care and Health Technology (ciTechCare), Escola Superior de Saúde de Leiria (ESSLei), Instituto Politécnico de Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901, Leiria, Portugal
| | - Alexandre V Abrantes
- Health Policy and Administration Department, Escola Nacional de Saúde Pública - Universidade NOVA de Lisboa (ENSP-UNL), Avenida Padre Cruz, 1600-560, Lisbon, Portugal
| | - Maria R O Martins
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Rua da Junqueira 100, 1349-008, Lisbon, Portugal
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Brugueras S, Rius C, Millet JP, Casals M, Caylà JA. Does the economic recession influence the incidence of pertussis in a cosmopolitan European city? BMC Public Health 2019; 19:144. [PMID: 30717741 PMCID: PMC6360796 DOI: 10.1186/s12889-019-6448-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 01/17/2019] [Indexed: 11/30/2022] Open
Abstract
Background In the last few years, pertussis has re-emerged worldwide. The aim of this article is to study how the incidence of the disease has evolved in Barcelona city over a 16-year period, and determine which factors are associated with the evolution of the disease. We discuss the causes of the observed changes considering different possibilities such as vaccination coverage, vaccine effectiveness, increased surveillance or the effect of the current economic recession. Methods We performed a cross-sectional, observational, population-based descriptive study using data for the 2000–2015 period from the notifiable diseases register maintained by Barcelona Public Health Agency. We used Poisson regression to compute adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (CI). Results A total of 1791 cases were registered. The incidence of the disease increased throughout the city from 2011 onwards. While children under 1 year of age had the highest-incidence and were the most at risk (aOR = 27.18, CI:23.51–31.44), we found that the age of affected children was higher in the last years. Incidence proportion (PRR) was lower among foreign-born children than native children (PRR = 0.43 CI:0.32–0.58). In the whole-cell vaccine period (2000–2004), the percentage of cases under 1 year of age who received the vaccine was lower than in 2005–2015 when the acellular vaccine was used (p = 0.01), suggesting a lower efficacy of the acellular vaccine. However, vaccination coverage in children under 6 years remained high (~ 90%), and there were no significant year-to-year variations (p = 0.757). Moreover, there did not appear to be any significant restrictions in medical care. According to the index of disposable household income (DHI), pertussis incidence increased from 2011 onwards in all neighbourhoods and remained higher in those with lower DHI. Conclusions The noteworthy increase in pertussis incidence does not seem to be due to the economic recession, but to other factors here described.
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Affiliation(s)
- Sílvia Brugueras
- Servei d'epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Departamento de Pediatría, Obstetricia y Ginecología y Medicina Preventiva, Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Cristina Rius
- Servei d'epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Departamento de Pediatría, Obstetricia y Ginecología y Medicina Preventiva, Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan-Pau Millet
- Servei d'epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Tuberculosis Research Unit Foundation (fuiTB), Barcelona, Spain
| | - Martí Casals
- Sport and Physical Activity Studies Centre (CEEAF), University of Vic-Central University of Catalonia (UVic-UCC), Barcelona, Spain
| | - Joan A Caylà
- Servei d'epidemiologia, Agència de Salut Pública de Barcelona, Barcelona, Spain.,Tuberculosis Research Unit Foundation (fuiTB), Barcelona, Spain
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Abstract
Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate - composed of the European Commission, the International Monetary Fund, and the European Central Bank - signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens' life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts-related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.
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Affiliation(s)
- Alexandre Morais Nunes
- 1 CAPP, Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa, Lisbon, Portugal.,2 CERis, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Suijkerbuijk AWM, Over EAB, van Aar F, Götz HM, van Benthem BHB, Lugnér AK. Consequences of restricted STI testing for young heterosexuals in the Netherlands on test costs and QALY losses. Health Policy 2018; 122:198-203. [PMID: 29246657 DOI: 10.1016/j.healthpol.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 10/02/2017] [Accepted: 12/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Due to rising costs caused by increasing demand for sexually transmitted infection (STI) care, the Dutch government changed the funding of STI clinics. In 2015, a more restrictive testing policy was introduced with syphilis and HIV tests only on indication for younger, heterosexual clients. We evaluated intended savings and missed syphilis and/or HIV infections and explored efficiency of possible test policies. METHODS Using surveillance data from 2011 to 2013 with extensive testing for all, we estimated effects of restrictive testing on test costs, number of infections missed, costs per Quality Adjusted Life Year (QALY) lost, and calculated the net monetary benefit from a government perspective. RESULTS The 2015 policy led to estimated savings of €1.1 million, while missing approximately three HIV infections and seven syphilis infections annually. Savings were €435,000/QALY lost. If testing second-generation immigrants for syphilis and HIV, savings rose to €525,000/QALY lost. Offering an HIV test when diagnosed with chlamydia or gonorrhoea savings were €568,000/QALY lost. In a sensitivity analysis, the willingness-to-pay threshold had the highest impact on results. CONCLUSIONS The 2015 testing policy resulted in a modest decline of detected HIV and syphilis infections, generating substantial savings. Syphilis and HIV tests for both first- and second-generation immigrants and an HIV test in case of positive chlamydia or gonorrhoea diagnosis could reduce missed infections in a cost-effective way.
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Bonaccorsi G, Modesti PA. Health literacy, a new perspective for patient empowerment in the public health approach to hypertension. Intern Emerg Med 2017; 12:737-739. [PMID: 28378279 DOI: 10.1007/s11739-017-1657-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Guglielmo Bonaccorsi
- Dipartimento di Scienze della Salute, Universita' degli Studi di Firenze, Florence, Italy
| | - Pietro Amedeo Modesti
- Dipartimento di Medicina Sperimentale e Clinica, Universita' degli Studi di Firenze, Largo Brambilla 3, 50134, Florence, Italy.
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Schulz K, Peyre M, Staubach C, Schauer B, Schulz J, Calba C, Häsler B, Conraths FJ. Surveillance strategies for Classical Swine Fever in wild boar - a comprehensive evaluation study to ensure powerful surveillance. Sci Rep 2017; 7:43871. [PMID: 28266576 PMCID: PMC5339697 DOI: 10.1038/srep43871] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/01/2017] [Indexed: 11/09/2022] Open
Abstract
Surveillance of Classical Swine Fever (CSF) should not only focus on livestock, but must also include wild boar. To prevent disease transmission into commercial pig herds, it is therefore vital to have knowledge about the disease status in wild boar. In the present study, we performed a comprehensive evaluation of alternative surveillance strategies for Classical Swine Fever (CSF) in wild boar and compared them with the currently implemented conventional approach. The evaluation protocol was designed using the EVA tool, a decision support tool to help in the development of an economic and epidemiological evaluation protocol for surveillance. To evaluate the effectiveness of the surveillance strategies, we investigated their sensitivity and timeliness. Acceptability was analysed and finally, the cost-effectiveness of the surveillance strategies was determined. We developed 69 surveillance strategies for comparative evaluation between the existing approach and the novel proposed strategies. Sampling only within sub-adults resulted in a better acceptability and timeliness than the currently implemented strategy. Strategies that were completely based on passive surveillance performance did not achieve the desired detection probability of 95%. In conclusion, the results of the study suggest that risk-based approaches can be an option to design more effective CSF surveillance strategies in wild boar.
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Affiliation(s)
- Katja Schulz
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Marisa Peyre
- Centre de Coopération Internationale en Recherche Agronomique Pour le Développement (CIRAD), Département ES, UPR AGIRs, TA C22/E, Campus International de Baillarguet, 34398 Montpellier Cedex 5, France
| | - Christoph Staubach
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Birgit Schauer
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Jana Schulz
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Clémentine Calba
- Centre de Coopération Internationale en Recherche Agronomique Pour le Développement (CIRAD), Département ES, UPR AGIRs, TA C22/E, Campus International de Baillarguet, 34398 Montpellier Cedex 5, France
| | - Barbara Häsler
- Royal Veterinary College, Veterinary Epidemiology, Economics and Public Health Group Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK
| | - Franz J Conraths
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany
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Ben Fredj M, Sriha Belguith A, Abroug H, Dhouib W, El Mhamdi S, Ben Salah A, Bouanene I, Amara A, Bhiri S, Sahtout M, Loussaief C, Soussi Soltani M. Hospitalizations for communicable diseases in a developing country: prevalence and trends-Monastir, Tunisia, 2002-2013. Int J Infect Dis 2017; 55:102-108. [PMID: 28104505 DOI: 10.1016/j.ijid.2017.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/01/2017] [Accepted: 01/09/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In spite of the epidemiological transition, communicable diseases remain a public health problem and represent a significant cause of morbidity and mortality worldwide, especially in developing countries. This study aimed to determine the crude and standardized prevalence rates of hospitalizations for communicable disease (HCD) and to assess trends in HCD by age and sex at a university hospital in Tunisia over a period of 12 years (2002-2013). METHODS All cases of HCD from 2002 to 2013 in the university hospital departments were included. Data collected from the regional register of hospital morbidity were used. The discharge diagnoses were coded according to the International Classification of Diseases, 10th revision (ICD-10). RESULTS HCD represented 17.45% of all hospitalizations during the study period (34 289/196 488; 95% confidence interval 17.28-17.62%). The median age at the time of admission was 31 years (interquartile range (IQR) 15-52 years). The median hospital length of stay (LOS) was 5days (IQR 3-9 days). The crude prevalence rate (CPR) was 5.41 per 1000 inhabitants. The CPR was highest among patients aged ≥65 years. The four communicable disease categories that represented 70% of all HCD were abdominal infection, skin infection, genitourinary infection, and lower respiratory tract infection. The majority of HCD decreased over time; however, there was a significant increase in HIV diseases, tuberculosis, and viral hepatitis. CONCLUSION This study provides evidence of the epidemiological transition, showing a decline in communicable diseases, which needs to be sustained and improved.
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Affiliation(s)
- Manel Ben Fredj
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Asma Sriha Belguith
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia.
| | - Hela Abroug
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Family Medicine, Faculty of Medicine, Monastir, Tunisia
| | - Sana El Mhamdi
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Arwa Ben Salah
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Inès Bouanene
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Amal Amara
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Sana Bhiri
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
| | | | - Chawki Loussaief
- Department of Infectious Diseases, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Mohamed Soussi Soltani
- Research Laboratory (LR12 SP17), Department of Epidemiology and Preventive Medicine, University Hospital of Monastir, Monastir, Tunisia
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Shanmugasundaram T, Radhakrishnan M, Gopikrishnan V, Kadirvelu K, Balagurunathan R. In vitro antimicrobial and in vivo wound healing effect of actinobacterially synthesised nanoparticles of silver, gold and their alloy. RSC Adv 2017. [DOI: 10.1039/c7ra08483h] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Antibacterial, antifungal and wound healing potential of actinobacterially synthesised Ag, Au and Ag/Au nanoparticles.
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Affiliation(s)
| | | | | | - Krishna Kadirvelu
- DRDO-BU Centre for Life Sciences
- Bharathiar University Campus
- Coimbatore 641 046
- India
| | - Ramasamy Balagurunathan
- Actinobacterial Research Laboratory
- Department of Microbiology
- Periyar University
- Salem 636 011
- India
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Shivaji T, Cortes Martins H. Improving data management practices in the Portuguese HIV/AIDS surveillance system during a time of public sector austerity. BMJ Qual Improv Rep 2016; 4:bmjquality_uu209037.w3663. [PMID: 26734448 PMCID: PMC4693107 DOI: 10.1136/bmjquality.u209037.w3663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/17/2015] [Indexed: 11/30/2022]
Abstract
In a climate of public sector austerity, the demand for accurate information about disease epidemiology rises as health program managers try to align spending to health needs. A policy of case re-notification to improve HIV information quality resulted in a nine-fold increase in the number of case reports received in 2013 by the Portuguese HIV surveillance office. We used value stream mapping to introduce improvements to data processing practices, identify and reduce waste. Two cycles of improvement were trialled. Before intervention, processing time was nine minutes and 28 seconds (95%CI 8:53–10:58) per report. Two months post intervention, it was six minutes and 34 seconds (95% CI 6:25–6:43). One year after the start of the project, processing time was five minutes and 20 seconds (95% CI 1:46–8:52).
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Affiliation(s)
- Tara Shivaji
- Directorate General of Health and the National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal, European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Helena Cortes Martins
- Directorate General of Health and the National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal, European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Abstract
OBJECTIVE In the past decades economic sanctions have been used by different countries or international organizations in order to deprive target countries of some transactions. While the sanctions do not target health care systems or public health structures, they may, in fact, affect the availability of health care in target countries. In this study, we used media analysis to assess the impacts of recent sanctions imposed by the Central Bank of Iran in 2012 on access to medicines in Iran. METHODS We searched different sources of written news media including a database of nonspecialized weeklies and magazines, online news sources, web pages of daily newspapers and healthcare oriented weeklies from 2011 to 2013. We searched the sources using the general term "medicine" to reduce the chances of missing relevant items. The identified news media were read, and categorized under three groups of items announcing "shortage of medicines," "medicines related issues" and "no shortage." We conducted trend analyzes to see whether the news media related to access to medicines were affected by the economic sanctions. FINDINGS A total number of 371 relevant news media were collected. The number of news media related to medicines substantially increased in the study period: 30 (8%), 161 (43%) and 180 (49%) were published in 2011, 2012 and 2013, respectively. While 145 (39%) of media items referred to the shortage of medicines, 97 (26%) reported no shortage or alleviating of concerns. CONCLUSION Media analysis suggests a clear increase in the number of news media reporting a shortage in Iran after the sanctions. In 2013, there were accompanying increases in the number of news media reporting alleviation of the shortages of medicines. Our analysis provides evidence of negative effects of the sanctions on access to medicines in Iran.
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Affiliation(s)
- Mehrnaz Kheirandish
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran ; Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Bigdeli
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Sotiropoulou P, Gourgoulianis K, Konstantinou K, Petinaki E, Roupa Z. RETROSPECTIVE STUDY OF MEASURING TUBERCULOSIS THERAPY COMPLIANCE: GREECE AS A HOST COUNTRY FOR VULNERABLE POPULATIONS BEFORE AND DURING THE FINANCIAL CRISIS. Mater Sociomed 2015; 27:328-32. [PMID: 26622200 PMCID: PMC4639346 DOI: 10.5455/msm.2015.27.328-332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For the realization of "2015 UN Millennium Development Goals", a question arises pertaining to the course of tuberculosis in Greece and its relationship to patient adherence to treatment, given the fact that the country is undergoing a financial crisis and is a gateway for economic migrants. METHODS The study concerned 1179 patients of the anti-TBdepartment, "Sotiria" General Chest Diseases Hospital, Athens, Greece collaborating with the National Reference Centre of Mycobacteria, covering a year before the financial crisis, 2007 and 2010-11, the first years of the crisis. A special recording form was used, on the basis of a specific protocol. RESULTS Out of 954 patients were diagnosed with tuberculosis disease, 657 of which were foreigners. Out of 791 patients residing in the same area, 632 were foreigners. Of the patients who proceeded to a first self-discontinuation of the medication, only 38.3% (n=18) completed the treatment, while 40.4% of them self-discontinued within the first month. Duration of treatment was 6.68±3.54 months for those (n=805) with no discontinuation and 7.48±3.68 months for those (n=149) with at least one discontinuation, regardless of the etiology p= 0,032. Cases increased during financial crisis, with gradual decrease in mean treatment duration for patients with first line treatment to 7.77±3.81 months in 2007, and 6.53±3.47 and 6.40±3.31 months in 2010 and 2011, respectively. CONCLUSIONS Since the beginning of treatment measurable signs of either adherent/non-adherent behavior appeared, affecting mean treatment duration and completion. Duration of treatment decreased in the years of financial crisis. Migrants ghettoization calls for implementation of DOTS.
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Affiliation(s)
- Penelope Sotiropoulou
- Department of Public Health and Community Health, Technological Educational Institute of Athens, Athens, Greece
| | | | | | - Efthimia Petinaki
- Microbiology Section, Department of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Zoe Roupa
- School of Sciences and Engineering, Department of Life and Health Sciences, University of Nicosia, Cyprus
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Reeves A, Basu S, McKee M, Sandgren A, Stuckler D, Semenza JC. Tuberculosis control and economic recession: longitudinal study of data from 21 European countries, 1991-2012. Bull World Health Organ 2015; 93:369-79. [PMID: 26240458 PMCID: PMC4450704 DOI: 10.2471/blt.14.142356] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 01/26/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate whether the economic recession affected the control of tuberculosis in the European Union. Methods Multivariate regression models were used to quantify the association between gross domestic product, public health expenditure and tuberculosis case detection rates, using data from 21 European Union member states (1991–2012). The estimated changes in case detection attributable to the recession were combined with mathematical models of tuberculosis transmission, to project the potential influence of the recession on tuberculosis epidemiology until 2030. Findings Between 1991 and 2007, detection rates for sputum-smear-positive tuberculosis in the European Union were stable at approximately 85%. During the economic recession (2008–2011) detection rates declined by a mean of 5.22% (95% confidence interval, CI: 2.54–7.90) but treatment success rates showed no significant change (P = 0.62). A fall in economic output of 100 United States dollars per capita was associated with a 0.22% (95% CI: 0.05–0.39) mean reduction in the tuberculosis case detection rate. An equivalent fall in spending on public health services was associated with a 2.74% (95% CI: 0.31–5.16) mean reduction in the detection rate. Mathematical models suggest that the recession and consequent austerity policies will lead to increases in tuberculosis prevalence and tuberculosis-attributable mortality that are projected to persist for over a decade. Conclusion Across the European Union, reductions in spending on public health services appear to have reduced tuberculosis case detection and to have increased the long-term risk of a resurgence in the disease.
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Affiliation(s)
- Aaron Reeves
- Manor Road Building, Department of Sociology, University of Oxford, Oxford, OX1 3UQ, England
| | - Sanjay Basu
- School of Medicine, Stanford University, Palo Alto, United States of America
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, England
| | - Andreas Sandgren
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - David Stuckler
- Manor Road Building, Department of Sociology, University of Oxford, Oxford, OX1 3UQ, England
| | - Jan C Semenza
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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O'Riordan M, Fitzpatrick F. The impact of economic recession on infection prevention and control. J Hosp Infect 2015; 89:340-5. [PMID: 25639208 DOI: 10.1016/j.jhin.2014.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/25/2014] [Indexed: 11/20/2022]
Abstract
The economic recession that began in 2007 led to austerity measures and public sector cutbacks in many European countries. Reduced resource allocation to infection prevention and control (IPC) programmes is impeding prevention and control of tuberculosis, HIV and vaccine-preventable infections. In addition, higher rates of infectious disease in the community have a significant impact on hospital services, although the extent of this has not been studied. With a focus on quick deficit reduction, preventive services such IPC may be regarded as non-essential. Where a prevention programme succeeds in reducing disease burden to a low level, its very success can undermine the perceived need for the programme. To mitigate the negative effects of recession, we need to: educate our political leaders about the economic benefits of IPC; better quantify the costs of healthcare-associated infection; and evaluate the effects of budget cuts on healthcare outcomes and IPC activities.
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López-Cuadrado T, Llácer A, Palmera-Suárez R, Gómez-Barroso D, Savulescu C, González-Yuste P, Fernández-Cuenca R. Trends in infectious disease mortality rates, Spain, 1980-2011. Emerg Infect Dis 2014; 20:782-9. [PMID: 24750997 PMCID: PMC4012808 DOI: 10.3201/eid2005.131528] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Using mortality data from National Institute of Statistics in Spain, we analyzed trends of infectious disease mortality rates in Spain during 1980-2011 to provide information on surveillance and control of infectious diseases. During the study period, 628,673 infectious disease-related deaths occurred, the annual change in the mortality rate was -1.6%, and the average infectious disease mortality rate was 48.5 deaths/100,000 population. Although the beginning of HIV/AIDS epidemic led to an increased mortality rate, a decreased rate was observed by the end of the twentieth century. By codes from the International Classification of Diseases, 9th revision, the most frequent underlying cause of death was pneumonia. Emergence and reemergence of infectious diseases continue to be public health problems despite reduced mortality rates produced by various interventions. Therefore, surveillance and control systems should be reinforced with a goal of providing reliable data for useful decision making.
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Suk JE, Van Cangh T, Beauté J, Bartels C, Tsolova S, Pharris A, Ciotti M, Semenza JC. The interconnected and cross-border nature of risks posed by infectious diseases. Glob Health Action 2014; 7:25287. [PMID: 25308818 PMCID: PMC4195207 DOI: 10.3402/gha.v7.25287] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 01/01/2023] Open
Abstract
Infectious diseases can constitute public health emergencies of international concern when a pathogen arises, acquires new characteristics, or is deliberately released, leading to the potential for loss of human lives as well as societal disruption. A wide range of risk drivers are now known to lead to and/or exacerbate the emergence and spread of infectious disease, including global trade and travel, the overuse of antibiotics, intensive agriculture, climate change, high population densities, and inadequate infrastructures, such as water treatment facilities. Where multiple risk drivers interact, the potential impact of a disease outbreak is amplified. The varying temporal and geographic frequency with which infectious disease events occur adds yet another layer of complexity to the issue. Mitigating the emergence and spread of infectious disease necessitates mapping and prioritising the interdependencies between public health and other sectors. Conversely, during an international public health emergency, significant disruption occurs not only to healthcare systems but also to a potentially wide range of sectors, including trade, tourism, energy, civil protection, transport, agriculture, and so on. At the same time, dealing with a disease outbreak may require a range of critical sectors for support. There is a need to move beyond narrow models of risk to better account for the interdependencies between health and other sectors so as to be able to better mitigate and respond to the risks posed by emerging infectious disease.
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Affiliation(s)
- Jonathan E Suk
- European Centre for Disease Prevention and Control, Stockholm, Sweden; Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK;
| | - Thomas Van Cangh
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Julien Beauté
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Cornelius Bartels
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Svetla Tsolova
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Massimo Ciotti
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jan C Semenza
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Briones-Vozmediano E, Agudelo-Suarez AA, Goicolea I, Vives-Cases C. Economic crisis, immigrant women and changing availability of intimate partner violence services: a qualitative study of professionals' perceptions in Spain. Int J Equity Health 2014; 13:79. [PMID: 25205287 PMCID: PMC4172960 DOI: 10.1186/s12939-014-0079-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/29/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Since 2008, Spain has been in the throes of an economic crisis. This recession particularly affects the living conditions of vulnerable populations, and has also led to a reversal in social policies and a reduction in resources. In this context, the aim of this study was to explore intimate partner violence (IPV) service providers’ perceptions of the impact of the current economic crisis on these resources in Spain and on their capacity to respond to immigrant women’s needs experiencing IPV. Methods A qualitative study was performed based on 43 semi-structured in-depth interviews to social workers, psychologists, intercultural mediators, judges, lawyers, police officers and health professionals from different services dealing with IPV (both, public and NGO’s) and cities in Spain (Barcelona, Madrid, Valencia and Alicante) in 2011. Transcripts were imported into qualitative analysis software (Atlas.ti), and analysed using qualitative content analysis. Results We identified four categories related to the perceived impact of the current economic crisis: a) “Immigrant women have it harder now”, b) “IPV and immigration resources are the first in line for cuts”, c) “ Fewer staff means a less effective service” and d) “Equality and IPV policies are no longer a government priority”. A cross-cutting theme emerged from these categories: immigrant women are triply affected; by IPV, by the crisis, and by structural violence. Conclusion The professionals interviewed felt that present resources in Spain are insufficient to meet the needs of immigrant women, and that the situation might worsen in the future. Electronic supplementary material The online version of this article (doi:10.1186/s12939-014-0079-1) contains supplementary material, which is available to authorized users.
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Llácer A, Fernández-Cuenca R, Martínez-Navarro F. Crisis económica y patología infecciosa. Informe SESPAS 2014. Gaceta Sanitaria 2014; 28 Suppl 1:97-103. [DOI: 10.1016/j.gaceta.2014.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/18/2014] [Accepted: 02/18/2014] [Indexed: 11/15/2022]
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Abstract
BACKGROUND A number of health outcomes were affected by previous financial crises, e.g. suicides, homicides and transport accident mortality. Aim of this study was to analyse the effects of the current financial crisis on selected health outcomes at population level in Europe. METHODS A mixed approach of ecologic and time trend design was applied, including correlation analysis. For eight countries, data on the economic situation (unemployment rate and economic growth) and health indicators (overall mortality, suicide and transport accident mortality) was drawn from EUROSTAT database for 2000-10. Spearman's rank correlation was applied to analyse the influence of social protection on the association between exposure and outcome variables. RESULTS The financial crisis had no visible effect on overall mortality in any of the eight countries until 2010. Transport accident mortality decreased in all eight countries, in the range of 18% in Portugal to 52% in Slovenia. In contrast, suicide mortality increased in Germany (+5.3%), Portugal (+5.2%), Czech Republic (+7.6%), Slovakia (+22.7%) and Poland (+19.3%). The effect of unemployment on suicide is higher in countries with lower social spending (Spearman's r = -0.83). DISCUSSION Clear cause-effect relations could not be established owing to the ecological study design and issues concerning data availability. However, there are clear changes in suicide and transport accident mortality after onset of the crisis, and findings are consistent with previous work. As part of this work, a comprehensive framework was developed, which can be applied to analyse health effects of financial crises in more detail.
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Affiliation(s)
- Anja Baumbach
- 1 Department of Epidemiology and International Public, Bielefeld University, School of Public Health, Health, Bielefeld, Germany
| | - Gabriel Gulis
- 2 Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
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Abstract
The economic crisis is the major theme in the Eurozone and its impact on public health and outcomes is largely discussed. Under this pressure, concerns of further inequalities exist that may have an impact on the burden of several diseases in certain European countries. In this context, Greece is currently an issue of top interest in any international economic discussion. Although the background of the recession has been largely discussed as a political crisis, its health effects on the population, as well as the key role of primary care and general practice/family medicine in health care reform remain to be explored. Serving both the worldwide trend of orienting health care systems towards strengthened primary care and the inner need for minimizing the demand and lessening the burden from the dysfunctional and costly hospital-care system, the economic crisis sets the perfect timing for prioritizing primary health care. In this article a unique window of opportunity for health care reform in Greece is examined, attempting to establish the axes of an example of how health care system can be reshaped amidst the economic crisis. Equity, quality, value framework, medical professionalism, information technology and decentralization emerge as topics of central interest. There is no doubt that Europe is transitioning under challenging social, economic and public health perspectives. However, taking Greece as an example, the current economic situation sets a good timing for health care reform and the key messages of this paper could be used by other countries facing similar problems.
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Lim TA, Marinova L, Kojouharova M, Tsolova S, Semenza JC. Measles outbreak in Bulgaria: poor maternal educational attainment as a risk factor for medical complications. Eur J Public Health 2013; 23:663-9. [PMID: 23302763 DOI: 10.1093/eurpub/cks182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND An 8-year era of interrupted indigenous measles transmission in Bulgaria came to an end in April 2009 when a large epidemic occurred that would eventually claim 24,253 cases and 24 deaths; infants, children and young adults of the Roma community were disproportionally affected. Compared with Western Europe, case-fatality rate and proportion of medical complications were uncharacteristically high. METHODS To disentangle underlying drivers of the outbreak and reasons for these medical complications, we assembled a number of national ecologic variables as well as regional individual-level data for 206 measles cases, randomly selected from national medical records. We conducted a logit regression analysis of data from individuals with medical complications. RESULTS Ecologic socio-economic predictors were not associated with measles cases by region, although the proportion of medical complications differed considerably. Individual-level data from a region with high medical complications revealed that mother's education [odds ratio (OR) 0.79; 95% confidence interval (CI) 0.68-0.92], immunization status of the child (OR 0.28; 95% CI 0.08-0.94) and households declaring an income (OR 0.31; 95% CI 0.10-0.93) decreased the risk for developing severe medical complications such as pneumonia or encephalitis from a measles infection. DISCUSSION The extent of this outbreak with a high case-fatality rate and high proportion of medical complications calls for resolute public health action. We found vaccination and maternal education to be crucial conduits of curbing medical complications from measles infections. Ultimately, the goal is measles elimination in Europe by 2015, and these data hint at intervention entry points.
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Affiliation(s)
- Tek-Ang Lim
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Semenza JC, Svederud I, Medin E, Orrskog S, Tsolova S. Mapping ongoing European research activities examining the infectious aetiology of chronic conditions. Clin Microbiol Infect 2012; 19:814-21. [PMID: 23046318 DOI: 10.1111/1469-0691.12030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic conditions contribute to the majority of the mortality and morbidity burden in Europe. The extent to which infectious agents are responsible for the chronic disease burden remains elusive. The complex nature of the natural history of chronic conditions calls for an overview of ongoing research activities linking infectious agents with these conditions in order to guide research endeavours, direct research funding, steer prevention efforts, and point health policy towards promising interventions. A selection of websites hosted by institutions either financing or conducting research within the European Union was screened for ongoing research activities examining infectious aetiology of chronic conditions. The searches were conducted until September 2011, applying search strategies and inclusion criteria predefined in a study protocol. In total, 25 research activities met the inclusion criteria. Of those, ten activities were focused to investigate infectious aetiology of cancer, four focused on type 2 diabetes mellitus, and 11 focused on a wide spectrum of other chronic conditions. The identified research projects did not cover areas such as mental and behavioural disorders. Infectious agents analysed included enteroviruses, Epstein-Barr virus, human rhinoviruses, P. gingivalis, human papillomaviruses, cytomegalovirus, Helicobacter spp. and human parvovirus. Only three projects specifically addressed therapeutic interventions. Ultimately, linking infectious agents with chronic conditions may translate into prevention efforts with vaccinations or treatment strategies with antimicrobial agents, and could, thus, eventually reduce the heavy disease burden from chronic conditions. However, little translational research on therapeutic interventions was found in our search and should be fostered, particularly for more established infectious-chronic disease associations.
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Affiliation(s)
- J C Semenza
- European Centres for Disease Prevention and Control, Stockholm, Sweden.
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Vittecoq M, Thomas F, Jourdain E, Moutou F, Renaud F, Gauthier-Clerc M. Risks of emerging infectious diseases: evolving threats in a changing area, the mediterranean basin. Transbound Emerg Dis 2012; 61:17-27. [PMID: 22998374 DOI: 10.1111/tbed.12012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Indexed: 11/27/2022]
Abstract
The Mediterranean basin is a biodiversity hotspot; it has historically had a large human presence that has shaped ecosystems for millennia. As the cradle of many civilizations, the area was one of the main theatres for transitions that punctuated both human and pathogen histories, which are intimately linked. Today we are living through another great historical transition summarized in the expression 'global changes'. In this context, we are witnessing a rise in the emergence of pathogens widely associated with aforementioned global changes. The Mediterranean basin might be especially vulnerable to this phenomenon due to the acute consequences global changes will have in this key intercontinental interface region. In addition, Arab revolutions and European economic crisis are creating both sanitary issues and presenting new opportunities to improve infectious disease control and prevention in the region. The aim of this review is to identify the impacts that ongoing changes might have on the risk of infectious disease emergence in the Mediterranean basin. We focussed on three key domains undergoing transformations: (i) resources, namely safe drinking water and animal products, (ii) socio-economic factors including health inequalities within countries and poor sanitary conditions linked to ongoing conflicts and (iii) movements of people and goods that are reshaped by current changes and are intimately linked to the risk of disease proliferation. Building on recent examples, we try to identify upcoming challenges and discuss ways to meet them in the light of existing international human and veterinary health guidelines and their possible improvements.
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Affiliation(s)
- M Vittecoq
- Centre de Recherche de la Tour du Valat, Arles, France; Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle, UMR (IRD/CNRS/UM) 5290, Montpellier, France
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Semenza JC, Suk JE, Estevez V, Ebi KL, Lindgren E. Mapping climate change vulnerabilities to infectious diseases in Europe. Environ Health Perspect 2012; 120:385-92. [PMID: 22113877 PMCID: PMC3295348 DOI: 10.1289/ehp.1103805] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 11/23/2011] [Indexed: 05/03/2023]
Abstract
BACKGROUND The incidence, outbreak frequency, and distribution of many infectious diseases are generally expected to change as a consequence of climate change, yet there is limited regional information available to guide decision making. OBJECTIVE We surveyed government officials designated as Competent Bodies for Scientific Advice concerning infectious diseases to examine the degree to which they are concerned about potential effects of climate change on infectious diseases, as well as their perceptions of institutional capacities in their respective countries. METHODS In 2007 and 2009/2010, national infectious disease experts from 30 European Economic Area countries were surveyed about recent and projected infectious disease patterns in relation to climate change in their countries and the national capacity to cope with them. RESULTS A large majority of respondents agreed that climate change would affect vector-borne (86% of country representatives), food-borne (70%), water-borne (68%), and rodent-borne (68%) diseases in their countries. In addition, most indicated that institutional improvements are needed for ongoing surveillance programs (83%), collaboration with the veterinary sector (69%), management of animal disease outbreaks (66%), national monitoring and control of climate-sensitive infectious diseases (64%), health services during an infectious disease outbreak (61%), and diagnostic support during an epidemic (54%). CONCLUSIONS Expert responses were generally consistent with the peer-reviewed literature regarding the relationship between climate change and vector- and water-borne diseases, but were less so for food-borne diseases. Shortcomings in institutional capacity to manage climate change vulnerability, identified in this assessment, should be addressed in impact, vulnerability, and adaptation assessments.
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Affiliation(s)
- Jan C Semenza
- Office of the Chief Scientist, European Centre for Disease Prevention and Control, Stockholm, Sweden.
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